Healthcare in Gaza: The Waiting Game

Healthcare in Gaza: The Waiting Game

DOUBLE THE PAIN: Khitam Abu Sultan (left), comforts her daughter Sabreen at the Makassed Hospital in Jerusalem. Sabreen lost her vision in one eye because of Israeli security’s prejudice. Her application to exit Gaza and seek medical care in Jerusalem was repeatedly rejected and her ambulance was delayed at the Erez Crossing.

Sabreen Abu Sultan, 32, turns over in her hospital bed, howling in pain. She had two head surgeries in the past three months to remove a tumor that was blocking her vision. As she twists and turns in her bed, her mother, Khitam, 61, tries to comfort her.

Not far from the Abu Sultan family’s room, on the same floor and ward at Makassed Charitable Hospital in the Mount of Olives area in East Jerusalem, 29-year-old Nasim Abu Tarabish lies in his bed with a bandaged nose, hardly able to speak.

Abu Tarabish also had a tumor pressing on his eyes and had to have it removed before it proved to be fatal. Next to him sits his father, Rafiq, 66.

The Abu Sultan family hails from Jabaliya in the Gaza Strip and the Tarabish family is from Gaza City. Hospitals in Gaza were not able to provide them with adequate medical treatment to save their lives, forcing them to transfer to more capable hospitals. But to leave Gaza and reach Palestinian hospitals in East Jerusalem or the West Bank, around 50 kilometers to the north, is not an easy task.

The Palestinian Ministry of Health says it is ready to provide critical Gaza patients with all-costs-paid transference papers to specialized hospitals in Jerusalem and the West Bank.

But in order to reach these hospitals, the patients have first and foremost have to obtain an exit permit from the Israeli occupation.

Such a permit, if ever received, would allow them to leave Gaza through its only exit point with Israel, the Erez crossing, to reach the West Bank or Jerusalem.

A 10-year Israeli military blockade, and Egypt to the South keeping shut the Rafah border crossing—Gaza Strip’s only exit to its Arab neighbor—have contributed to the decline in health and other services in the world’s most densely populated and impoverished coastal enclave.

Some 1.8 million people live in the 360 square kilometers Gaza Strip.

“Last October, doctors diagnosed a tumor in Sabreen’s head that was pressing on her eyes and causing her lots of pain,” says her mother, Khitam. “The doctors did not think that Gaza’s hospitals were qualified to operate on her and therefore suggested to transfer her to Makassed Hospital in Jerusalem,” she tells Newsweek Middle East.

In Abu Tarabish’s case, the doctors in Gaza thought they could operate on him by removing the tumor with a head operation.

His father, who is a medic, did not agree because he knew that at Makassed they could remove the tumor through the nose rather than opening up his head, which has a better chance of success, according to the father.

Both families began immediate steps to get their children the proper papers to reach Makassed Hospital. They obtained hospital appointments, which for Sabreen was May 10 and for Nasim June 18. The next step was to get the Israeli military’s permit and the procedure for that is relatively easy, but the outcome is never predictable.

The families sent their medical papers and appointment dates to the Palestinian Authority’s Civil Coordination Office, which in turn sent them over to its Israeli counterpart to issue the patients a permit. All that the families could do now was wait.

Normally, the Israeli reply arrives a day prior to the appointment date and could be one of three: a rejection; a request for a meeting with the military officer at the crossing point; or an acceptance.

In Nasim’s case, he was lucky and got an acceptance and therefore immediately travelled to Erez crossing and was able to reach Jerusalem in time for his hospital appointment.

But for Sabreen, the family was told to come for an interview with the military officer at Erez on May 9, a day prior to her hospital appointment.

“We went there on time but we got a rejection,” Khitam says.

“We do not know why they rejected her application. No reason was given to us,” she adds.

Meanwhile, as Sabreen’s health deteriorated, her family scrambled to find a way and applied for another appointment in hopes to get a permit.

The new hospital appointment was set for June 2. But on June 1, the Israeli military handed them another rejection.

“I had no choice but to admit my daughter to Shifa Hospital in Gaza and demand that she gets an emergency transfer to Makassed,” the mother says as she sits by her daughter’s side.

Sabreen was put in an ambulance and taken to Erez crossing.

“We waited there for hours while people and organizations intervened and pressured the Israeli government to allow us to cross into Jerusalem,” says Khitam.

Finally, the Israeli Shabac, the General Security Service (GSS), which has the sole responsibility of deciding who gets or does not get a permit, agreed to let them through but informed the mother and Sabreen very strictly that they were not to leave the hospital, not even to go and pray at Al Aqsa Mosque in Jerusalem.

Sabreen underwent an operation immediately upon arrival at the hospital and the tumor was removed from her head. But she lost sight in one of her eyes. Ten days later, the Abu Sultan family returned to Gaza. Sabreen later developed complications and was readmitted to Shifa hospital in Gaza. The hospital again referred her to Makassed for a follow-up appointment for August 4. Once more, her application to reach the hospital was rejected by the Israelis and the family was forced to follow the same measures as before and transfer Sabreen in an ambulance to Erez checkpoint, which worked and Sabreen made it to Makassed Hospital on time for her appointment.

Other patients in Gaza trying to reach a hospital in Jerusalem, the West Bank or even Jordan or Israel suffer a great deal to get there, and the majority do not even make it.

“Between 25 percent and 30 percent of Gaza’s patients wishing to come to Makassed or any other hospital outside Gaza for treatment had their application for an exit permit rejected,” Rafiq Husseini, director of Makassed Hospital, tells Newsweek Middle East.

“The only excuse we hear is that there is a security ban against them but no one really knows what the security reason is,” he adds.

In its monthly report on the referral of Gaza patients to other hospitals outside the Gaza Strip, the World Health Organization (WHO)’s office in the Palestinian territories says that three out of 10 patients were denied or delayed permit to exit Gaza.

“Of 2,105 applications for permits submitted by patients to exit Gaza through Erez checkpoint for hospital appointments in June, 69.31 percent were approved,” the report states. “209 patients (9.93 percent) were denied, including 6 children and 10 elderly persons over 60 years.” In addition, 437 patients (20.76 percent) received no response to their applications, including 135 children and 45 elderly people over 60. The report adds that 39 patients were ordered to go for GSS interviews at the Erez crossing in June. Only two were approved.

WHO says there was a decline in Israeli approvals for patients’ permit applications, and an increase in delays after July 2015.
“Delays were higher in 2016 compared to the 2015 average, possibly due to an increase in GSS requests for security interviews. Denials [for the permits] have been increasing since the beginning of the year.”

WHO has reported cases in the past in which a patient died while waiting for a permit to reach hospitals outside Gaza.

Every patient is also allowed only one companion to travel with him or her; but that companion should be old and a first degree relative, such as a father or mother.

In some instances, the GSS would approve the transfer of a patient and not the companion.

The WHO says the approval rate for patient companions’ permit applications was 58 percent in June.

In one case, Israel arrested a father of a 2.5-year-old boy as they were returning to Gaza after the son was taken to a hospital in Israel to donate bone marrow for his younger brother, who was getting treatment at that hospital.

The father was arrested and held for 15 days but then released without any charges. The boy was left at Erez crossing alone for several hours until his family members were able to get him.